Summary The fishing vessel MerseyVenture was discharging a cargo of shrimp alongside the wharf in Stormont, NovaScotia. Two stevedore gangs were working two hatches. The forward hatch is equipped with a freight elevator, which was in use. At approximately 1220 local time, the elevator rope hoist gearbox failed when the platform was at the upper limit of its travel, which caused the drum to freewheel and the platform to descend in a free-fall. Three of the four stevedores on the platform at the time of the failure received injuries consistent with elevator accidents, including shattered heels and broken bones. Ce rapport est galement disponible en franais. Factual Information Particulars of the Vessel Description of the Vessel The MerseyVenture is a single-screw, conventional stern freezer trawler of all-steel, welded construction. The navigating bridge and crew accommodations are forward of midships. The vessel has a large factory area, located one deck above a large refrigerated hold. There are two hatches, one located forward and the other aft. The forward hatch is equipped with a freight elevator. The vessel was built to Det Norske Veritas (DNV) Ice ClassA. It was imported, and registered in Canada in1988. Later, the DNV classification was dropped and the vessel became subject to inspection by Transport Canada Marine Safety (TCMS) under the Large Fishing Vessel Inspection Regulations. Description of the Elevator The elevator was supplied and installed as original equipment at new building by MacGregor-Navire (N) A/S, the marine division of Kone Incorporated. As installed, the elevator consisted of a platform which moved vertically in guides located on a steel structure within a hoistway enclosed on three sides. The device links the factory deck and the refrigerated hold below, with a height of lift of approximately 3.65metres. The lift main drive machine (a winding drum type ModelNoUN2B-1electric hoist) is located on top of the steel structure on the forward side. It had two suspension cables of 14mm diameter steel wire rope rove to advantage through two sheaves configured as single whip purchases. The system had two limit systems to control the vertical travel. The primary stage limit system was located on the rope hoist itself. A secondary stage limit system, using magnetic proximity limit switches, was mounted on the frame of the elevator. The switches provided redundancy in the event of a failure of the primary system. A load cell was installed on the rope hoist to prevent operation of the elevator in an overstressed condition. The safe working load of the elevator was rated at 3.5tonnes. Fishing Practices and Operating Environment The MerseyVenture is one of about a dozen large fishing vessels holding licences, issued under the Northern Shrimp Integrated Management Plan of the Department of Fisheries and Oceans, to fish northern (or pink) shrimp. Most vessels involved are purpose-built for shrimp trawling and range in length from 42.6m to 74.3m, with hold capacities from 400m3 to 1960m3. Fishing trips generally last until the hold is full, a period ranging from 25to 75days, depending on catch rates and hold capacity. To reduce broken stowage and maximize the vessel's earning capacity, boxes of processed frozen cooked or raw shrimp are stowed in all spaces of the hold, including the elevator platform in the hoistway. Elevator Inspections The elevator was inspected and a certificate issued by Kone when it was installed in August1988. In1992 and1996, it was subject to functional testing by TCMS. History Previous to the Occurrence Shortly after the vessel became operational, it was noticed that the steel wire ropes in the hoisting system were being damaged. Inspection by the ship's engineering personnel determined that the wire rope was being nipped by the rope guide while winding onto the drum of the rope hoist. Although investigation did not determine when the rope guide was removed, it may have been done while the vessel was in a refit in Norway in1992. Sometime after 1996 and prior to the occurrence, an angle iron bar on which the second stage limit switches were mounted was damaged and became detached from the frame of the elevator. The bar was subsequently tied off using twine and the limit switches disconnected. In September 1999, one of the elevator suspension wires parted, causing the platform to free-fall an estimated 1.2-2.4metres. The elevator had been loaded with an unknown quantity of boxed raw shrimp. There were no riders. The wires were renewed and the elevator placed back in service. The occurrence was not reported to any authority, federal or provincial, nor was the elevator inspected by a competent elevator mechanic or inspector. The Occurrence On 14 August 2000 at 08152, the MerseyVenture arrived at the Stormont wharf. At 1000, two stevedore gangs commenced unloading the ship. One gang worked the after hatch and were not involved in the occurrence. A second gang worked the elevator hoistway at the forward hatch to make room to break out and unload the product from the main part of the hold, which is common to both hatches. Approximately eight tonnes of frozen raw shrimp in 20kg boxes were unloaded from the elevator hoistway. Since the weight of the shrimp on the platform exceeded the cut out setting of the load cell, the stevedores began the process of clearing the hoistway by unloading enough product to reduce the weight on the platform to an amount that was below the cut out setting. The elevator platform was then raised in increments so that pallets could be made up at the factory deck level until the hoistway was cleared. The pallets were offloaded from the factory deck level as they were assembled and placed on the wharf by the ship's crane. Here, they were shrink-wrapped in plastic and weighed. The shrimp in the main hold was stowed from bottom to top in two levels, separated by a layer of plywood dunnage. Having cleared the hoistway, the stevedores began breaking out boxes of cooked shrimp from the top layer, making up pallets of 150boxes each on the deck of the elevator platform. The platform was suspended approximately half the distance up its vertical travel. The hoistway forms part of the hatch square to the upper deck. At this point, the elevator platform was being used as a working platform on which to make up pallets. The gang had made up and offloaded several pallets of product. A pallet was ready to be lifted ashore and was centred on the platform. At approximately 1220, six stevedores, working in the hold or on the suspended platform itself, boarded the platform to ride up to the factory deck level. The elevator was being operated by a seventh stevedore, using a wander lead (orpendant) at the factory deck level. As the platform approached the upper limit of its travel, it was stopped by the operator just below the level of the factory deck and two riders stepped off the platform. A moment later, the rope hoist main drive unit failed and the platform, with four riders still onboard, free-fell to the bottom of the hoistway. Three of the four riders received injuries consistent with elevator accidents, including shattered heels and broken bones in the foot and leg. The fourth rider was uninjured. When the platform came to rest, one of the riders was pinned underneath five kilogram boxes of frozen shrimp, which fell from the pallet when it collapsed on the platform. Immediately following the occurrence, other stevedores entered the hoistway to assist the injured. A call was made to the 911system, alerting the emergency services. One of the injured stevedores climbed from the hoistway on his own. The remaining two injured workers were extricated using the ship's crane and were transferred directly ashore from the hoistway where they were attended to by paramedics. Post Occurrence Upon activation of the 911system, the Royal Canadian Mounted Police (RCMP) responded to the accident site, secured the scene and initiated the protocol for workplace accidents. RCMP Sherbrooke Detachment called the Nova Scotia Department of Labour3 (NSDL), which in turn dispatched a safety officer from the local field office of the Occupational Safety and Health Division (NSDL-OSH) to the scene of the accident. Upon arrival at the scene, the safety officer issued a verbal stop work order until further investigation of the occurrence could proceed. Later that same day, confirmation in the form of a written stop work order was prepared and delivered to the owner of the vessel. Since the accident involved an elevating device, the officer requested the assistance of Elevator and Lifts Inspection Services of the NSDL Public Safety Division (NSDL-PSD), which is responsible for the licencing and inspection of elevators and lifts in the province of NovaScotia. On 16 August 2000 at 1120, an elevator inspector from NSDL-PSD, accompanied by local safety officers from the local NSDL-OSH office, attended the vessel and commenced an investigation. With the assistance of company maintenance personnel, the rope hoist was removed, disassembled and inspected. In addition to the damage to the rope hoist itself, this inspection detected numerous deficiencies including disabled and defeated safety devices. During this inspection, a surveyor from TCMS arrived on scene to investigate rumours of an accident occurring in the vessel. The TCMS surveyor met with the various provincial representatives and a discussion ensued. The TCMS inspector then issued a Ship Inspection Notice (SI7) with the condition the elevator not be used until repaired by an authorized manufacturer's representative.